In general, clinical manifestations of pregnant women with COVID 19 pneumonia were similar to non- pregnant adult patients like fever, cough and fatigue. From a retrospective review of medical records from nine pregnant patients with COVID-19 pneumonia, investigators found that clinical characteristics in pregnant women were similar to non-pregnant adult patients with COVID-19 infection. Main symptoms found among the pregnant patients were fever and cough. ⁶ Another study in 13 pregnant patients showed fever and fatigue commonly reported, with clinical manifestations varying widely from asymptomatic to very severe. ⁷

Limited data from laboratory tests of 9 pregnant patients indicated that lymphopenia is likely to occur as well as increased concentrations of ALT or AST. However, these are not specific to pregnant women with COVID-19 pneumonia. Five of the 9 pregnant women had lymphopenia (<1·0 × 10⁹ cells per L). Six patients had elevated C-reactive protein (>10 mg/L). Three had increased concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Additionally, seven patients had a normal white cell count, with none of the patients having a white cell count below the normal range. ⁶ CT scan from 8 patients showed typical findings of multiple patchy ground-glass shadows in lungs.

Pathological study of 3 placentas from pregnant women with COVID 19 infection suggests that there are no morphological changes related to infection. The placentas delivered from pregnant women in the 3rd trimester tested by RT-PCR were negative for the nucleic acid of 2019-nCoV. Various degrees of fibrin deposition with local syncytial nodule increases were observed. One case showed the placenta with the morphology of chorionic hemangioma and another one with massive placental infarction. No pathological change of villitis and chorioamnionitis was observed. ⁸

With the limited data available so far, it is still not known for certain if there is vertical transmission of SARS-COV-2 from pregnant women with COVID-19 infection.

Amniotic fluid, cord blood and neonatal throat swab samples collected from six patients tested negative for COVID-19, suggesting there was no evidence of intrauterine infection caused by vertical transmission in women who developed COVID-19 pneumonia in late pregnancy. There appeared to be no evidence of transmission on breastmilk. No fetal death, neonatal death or neonatal asphyxia was observed. All the newborns in the study had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. ⁶

In a recent cohort study from Wuhan Children's Hospital in Hubei Province of China, 3 of 33 infants (9%) born to COVID 19 affected mothers presented with early onset SARS-CoV-2 infection. 10 The neonates tested positive for SARS-CoV-2 on days 2 and 4 of life. Symptoms were mild and no neonatal death. One of the neonate was seriously ill but may have been due to prematurity, asphyxia, and sepsis. In light of their findings, the authors mentioned that it is crucial to screen pregnant women and implement strict infection control measures, quarantine of infected mothers, and close monitoring of neonates at risk of COVID-19.

The general principles regarding management of COVID-19 during pregnancy include early isolation, aggressive infection control procedures, testing for COVID 19 and co-infection, oxygen therapy as needed, avoidance of fluid overload, empiric antibiotics (due to secondary bacterial infection risk), fetal and uterine contraction monitoring, early mechanical ventilation for progressive respiratory failure, individualized delivery planning, and a team-based approach with multi-specialty consultations. ⁹

In general, use of corticosteroids in the treatment of COVID-19 pneumonia is not recommended as it may delay the virus clearance from the body. Data on effectiveness and safety need further evaluation. In China, short-term (3-5 days) administration of methylprednisolone (1-2 mg/Kg bodyweight per day) has been used frequently, especially when dyspnea and hypoxemia are severe. Betamethasone 12mg IM followed by another dose 24 hours later should be considered to promote fetal lung maturity when preterm delivery is anticipated. Antiviral treatment has been routinely used to treat COVID-19 infection in China, and is also recommended for pregnant patients. Combination therapy with antiproteases Lopinavir/Ritonavir has been the preferred drug regimen as it is known to be relatively safe in pregnancy. ¹